Necessity of Surgery as a Prerequisite for the Claim to Medical Measures for Congenital Tibial Torsion

Facts

A., born in 2005, suffers from various congenital health impairments, including congenital tibial torsion. On January 24, 2013, she underwent bilateral lower leg torsion correction surgery. The IV (Disability Insurance) office rejected the cost coverage for this procedure, as it did not consider the surgery to be necessary. However, the Insurance Court of the Canton of St. Gallen obliged the IV authorities to cover the costs. The Federal Office for Social Insurance subsequently filed an appeal with the Federal Supreme Court.

Considerations

The Federal Supreme Court states that according to the Ordinance on Congenital Defects (GgV), congenital tibial torsion is only recognized as a congenital defect triggering benefits if surgery is necessary. This criterion of surgical necessity serves to describe a certain degree of severity of the condition and is intended to exclude less severe manifestations from the obligation to provide benefits by the Disability Insurance.

The Federal Supreme Court finds that the…